22.C. Certificate of Decontamination
Disinfection and decontamination are required before shipping the instrument and
instrument accessories for repair. Instruments returned for service must be
accompanied by a signed and dated Certificate of Decontamination, which must be
attached to the outside packaging of the instrument.
1.
Clean the interior of the luminometer according to the instructions in Section 20.B.
2.
Clean the injectors according to the instructions in Section 20.E.
3.
Clean the Waste Tray according to the instructions in Section 20.F.
Failure to confirm disinfection and decontamination will result in decontamination
charges before the instrument will be serviced.
Select either (A) or (B):
A.
I confirm that the returned items have not been used with body fluids or
contaminated by toxic, carcinogenic, radioactive, or other hazardous materials.
B.
I confirm that the returned items have been decontaminated and can be handled
without exposing personnel to health hazards.
Circle the type of material used in the instrument:
Chemical
Biological
Radioactive**
Briefly describe the decontamination procedure performed:
Date:
Place:
Signature:
Name (block capital letters):
** The signature of a Radiation Safety Officer is also required if the instrument was
used with radioactive materials.
This instrument is certified by the undersigned to be free of radioactive
contamination.
Date:
Place:
Signature:
Name (block capital letters):
Promega Corporation ·
2800 Woods Hollow Road
·
Madison, WI 53711-5399 USA
Toll Free in USA 800-356-9526
·
Phone 608-274-4330
·
Fax 608-277-2516
· www.promega.com
Part# TM311
Printed in USA.
Page 90
Revised 5/10
